“We are now cruising at a level of two to the power of twenty-five thousand to one against and falling, and we will be restoring normality just as soon as we are sure what is normal anyway.”, Douglas Adams, The Hitchhiker’s Guide to the Galaxy
I am delighted to be able to present the latest Public Health Annual Report for Cumberland – the first to be produced since 1973, when the County Medical Officer, Dr John Leiper, presented his final annual report to Cumberland County Council before that body was subsumed into Cumbria County Council and the public health function transferred to the NHS. Forty years later public health was transferred back to local government, and now, fifty years later, Cumberland has itself returned.
You might think that a lot has changed in those fifty years. However at a time when we are seeing a measles outbreak across some parts of England it is notable that in the preface to his 1972 report, Dr Leiper reflects on the success of using “the County Council computer” to help achieve a 91% vaccination rate that “is slowly bringing under control those widespread outbreaks of measles which we have suffered from every alternate year in this country in the past” (our vaccination rate today is around 95%). He also reflects on evidence that the fluoridation of water supplies was already bringing improvements in dental health, an issue which remains live today, and bemoans the fact that “doctors, nurses and social workers are increasingly frustrated in that adequate arrangements cannot from time to time be found for the care of some of the diagnosed [psycho-geriatric] cases”. Some things, alas, remain challenges fifty years on.
Dr Leiper also reflects that “the care of the mentally disordered is in a state of great change, with increasing emphasis on community care both in cases of subnormality and mental illness and the year has seen wide ranging multi-disciplinary discussions about the implementation of this policy.” The outdated language notwithstanding, it is clear that challenges around mental health are also long standing – and this is the focus of this Public Heath Annual Report.
In some ways this report feels like the latest step on a long journey for me. My undergraduate degree was in psychology, and at the time I was particularly interested in the courses on what was then called “abnormal psychology”, and “social cognition” – which I later realised was a bit like undergoing a course of cognitive behavioural therapy, and which undoubtedly changed the way I saw the world. I was also interested in the course on addictions, and it was this that led me into working in drug policy; the rest, as they say, is history. In 2018 I focused the Cumbria Public Health Annual Report on the importance of adverse childhood experiences; in 2022/3 the focus was on our Health and Wellbeing Coach service, a team designed to take a different approach to supporting people to deal with the challenges they face. This current report can to some extent be seen as a logical progression from that personal history. It reflects on the rising rates of mental distress (as measured by demand for services) and challenges our tendency to medicalise many things that could in fact be seen as normal human experiences, or as reactions to abnormal situations. One inspiration for this report came when I started hearing about young people being diagnosed with “climate anxiety”. Being anxious about the environment may be distressing but it is not a mental health disorder: it’s a perfectly reasonable and rational response to our climate emergency, and the “treatment” is activism, not Prozac.
“Abnormal is so common, it’s practically normal”, Corey Doctorow, Little Brother
While tackling the social and economic factors that are driving what can be seen as a current mental health crisis is far from easy, the good news is that there is some strong evidence on what can be done to intervene. It will take a radical reimagining of what “normal” is, and of what mental health and neurodiversity support can look like but I believe that in Cumberland we are ready to rise to that challenge.
Colin Cox
Director of Public Health and Communities